Provider Demographics
NPI:1346698461
Name:RESTORING HOPE COUNSELING CENTER, LLC
Entity Type:Organization
Organization Name:RESTORING HOPE COUNSELING CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:LYNDA
Authorized Official - Middle Name:
Authorized Official - Last Name:WADE
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LAPC,NCC, DCC
Authorized Official - Phone:706-825-8491
Mailing Address - Street 1:618 PONDER PLACE DR
Mailing Address - Street 2:STE. 2
Mailing Address - City:EVANS
Mailing Address - State:GA
Mailing Address - Zip Code:30809-3117
Mailing Address - Country:US
Mailing Address - Phone:706-825-8491
Mailing Address - Fax:
Practice Address - Street 1:618 PONDER PLACE DR
Practice Address - Street 2:STE. 2
Practice Address - City:EVANS
Practice Address - State:GA
Practice Address - Zip Code:30809-3117
Practice Address - Country:US
Practice Address - Phone:706-825-8491
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-31
Last Update Date:2016-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC004984101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty